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PLRMIT APPLICATIC,N <br />CITY OF EVERETT PERMIT SERVICE:S <br />3200 CEDAR STREE?, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />1 � ��� n�L=�lF � l=. � <br />LEGHL LOT NO. <br />DESC. <br />OWNER'������ � �C; <br />APPLICATIONS ARE ACCEPTECI FROM B AM TU 4 PM <br />:�� L� � PARCEL TAX I.D. # <br />MAt_1_�'tA �=.C�= I �C��'"7 <br />BLOCK TRACT OR SUBDIVISION # <br />TENANT NAME �y <br />���—L'�V ��:4��W� <br />U L2:.lV 1��, <br />CONTi� LICENSEfi <br />USE OF BUILDING <br />���,vey �':A�-�,1� <br />P�Gx �C'���, <br />CONTACT �FOR PERMIT <br />��=L� t\�N�-t..��I-I <br />HEATSOURCE <br />_ Electric _ Gas _ Other c�n <br />�.� --0 <br />PERMIT # <br />�,c^�Gc� �- <br />iONE 'Z,��� (7�5 <br />�� �� I�1� <br />,� <br />PHONE y��i �7 S� I� I <br />E•MAIL <br />CONTRACT PRICE OF WORK <br />'-1� Y - ._ �-. _ __ _ ,-. <br />WORKDESCRI�TION ����^�� ��,/�����j�i�,���� F�j� S/�L�� <br />PLUi14EING <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lava(ory (wash basin) <br />Sftower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cblhes washer <br />Waler healer <br />Sink (service/badmop/elc.) <br />Backtlow preventer <br />Urinal <br />Drinking Founlain <br />Floar drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water hsaler <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritiiy that I h2ve read and examined ihis application and kno�v the same to be true and correcL All provisions of laws and <br />ordinaces c�overniog lhis type of work will be complied wilh H�helher sFecified herein or noL The granting of a permil does not presume <br />lo yive authority to violate or cancel the provision of any olher stale or local law regulating construclion or the pedormance o( <br />construction. Thal I am authorized by lhe owner of lhis property to per(orm the work for which applicalion is made and I comply with the <br />Slale Contraclors Law 18.27 RC'J�! and 296.200 WAC. <br />�, i�.,� � : � � > c��tihZ,� , �-Lc-_ �. �c <br />�; �� �a,�,�c.,E`-��1 � •, �, -1 - L. ( <br />Signalure of OwnedContraclodAuthorize Agent Date '/� <br />